Week 10, Spring 2008

The client visited the clinic because she stated that family members suspected that she had hearing loss. Although the client reported difficulty understanding speech in noise, she did not report difficulty hearing in quiet settings. She stated that her family believed that her hearing sensitivity had decreased gradually. A hearing evaluation by an ear, nose, and throat physician more than ten years ago revealed Eustachian tube dysfunction in the right ear, according to the client. She has continued feeling persistent fullness in her right ear since that time. Tinnitus was noted in both ears, but was described as only noticeable in complete quiet. The client stated that she did not feel bothered by the tinnitus. She related changes in the perceptibility of tinnitus to modifications of types and dosage of blood pressure, diabetes, and arthritis medications. No dizziness was noted. No other outstanding case history information was provided.

Cerumen accumulation, partially occluding the ear canal, were observed. Still, intact tympanic membranes were observed bilaterally. Slightly abnormal (Type AS) tympanograms were observed bilaterally.

Pure tone air conduction testing was performed from 250 to 8000 Hz, and pure tone bone conduction testing was performed at 500, 1000, 6000 Hz. Pure tone testing revealed normal hearing from 250 to 4000 Hz with a moderate high-frequency sensorineural loss bilaterally. A slight conductive component was observed at 6000 Hz in both ears. Speech recognition thresholds were 25 dB HL in the right ear and 10dB HL in the left ear. SRTs were in good agreement with pure tone averages bilaterally, and word recognition testing was excellent bilaterally.

Results were discussed with the client. Slightly abnormal tympanometric results and otoscopic examination of the ear canal indicated a moderate occlusion from cerumen. A bilateral, high-frequency sensorineural hearing loss was found.

The client was encouraged to see a physician in order to have excessive cerumen accumulation removed from her ear canals. Yearly hearing evaluations also were recommended in order to monitor her hearing sensitivity. Lastly, assistive devices, such as television amplifiers, were discussed with the client; however, she did not wish to pursue purchasing assistive technology at that time.

I could NOT resist including this article. It describes a man who was vacationing on an island. While on vacation, he experienced an impaction of cerumen. Instead of seeking medical treatment from an audiologist or other qualified health professional, he, instead, sought counsel from an engineer who owned the resort where he was staying. Otoscopy revealed bilateral impaction and hardening of the cerumen. The engineer suggested using a Super Soaker (water gun) to irrigate the man's ear. A family and emergency physician on the island was recruited to perform the irrigation after he assessed the Super Soaker's potential utility.

Here's the interesting part - when they irrigated with the Super Soaker ...

IT ACTUALLY WORKED!

Not only did it work, it did not cause pain, and it was much quicker and more efficient than typical irrigations from syringes.

Now...wouldn't clinic be even more interesting if we were using Super Soakers for cerumen management???

http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=18939158&site=ehost-live

http://web.ebscohost.com.www.libproxy.wvu.edu/ehost/pdf?vid=5&hid=116&sid=5b7088be-e3c7-45f7-9df3-20ac14811b59%40sessionmgr108

Here's a more scholarly article on a related topic.

http://web.ebscohost.com.www.libproxy.wvu.edu/ehost/pdf?vid=40&hid=101&sid=5077a623-7531-4b3a-a840-604f8d099f9b%40sessionmgr106

This study found that children with cerumen impaction are more prone to developing OME and also conductive hearing loss. Interestingly, a higher incidence of sensorineural and mixed hearing loss was also found in this population.